IMR Press / RCM / Volume 20 / Issue 4 / DOI: 10.31083/j.rcm.2019.04.564
Open Access Case Report
Alterations in Doppler-derived renal venous stasis index during decompensation of right heart failure and fluid overload in a patient with pulmonary hypertension
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1 Department of Internal Medicine II, Division of Nephrology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
2 Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Via Rodolfi, 37-36100 Vicenza, Italy
3 Department of Internal Medicine II, Division of Pulmonology and Critical Care Medicine, University Hospital Giessen and Marburg, 35392, Giessen, Germany
4 Universities of Giessen and Marburg Lung Center (UGMLC) [member of the German Center for Lung Research (DZL)], Klinikstrasse 33, 35392, Giessen, Germany
5 Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, 621 N Hall Street, Dallas, Texas 75226, USA
6 Intensive Care Unit, I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19-27100 Pavia, Italy
7 First Department of Medicine, Faculty of Medicine, University Medical Center Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
8 Fifth Department of Medicine, Faculty of Medicine, University Medical Center Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
9 Max Planck Institute for Heart and Lung Research, Parkstrasse 1, 61231 Bad Nauheim, Germany
10 Department of Pulmonology, Kerckhoff-Klinik, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
Rev. Cardiovasc. Med. 2019 , 20(4), 263–266; https://doi.org/10.31083/j.rcm.2019.04.564
Submitted: 15 September 2019 | Accepted: 28 November 2019 | Published: 30 December 2019
Abstract

Renal congestion is becoming recognized as a potential contributor to cardiorenal syndromes. Adequate control of congestion with simultaneous preservation of renal function has been proposed as a central goal of the management of heart failure. We report our care of a 48-year-old woman suffering from right heart failure and massive fluid overload due to severe pulmonary hypertension secondary to a combination of left-heart disease and status after recurrent pulmonary embolisms. Alterations in Doppler-derived intrarenal venous flow patterns and a novel renal venous stasis index were used to evaluate improvement in renal venous congestion during decompensation. Due to refractory congestion despite optimal medical treatment and continuous veno-venous hemodialysis, a peritoneal dialysis catheter was placed to relieve the massive ascites. The paracentesis of ascites led to a significant loss of weight, normalization of hydration status with subsequent termination of continuous veno-venous hemodialysis, and a significant improvement in clinical and echocardiographic parameters. Renal Doppler ultrasonography showed continuous improvement in intrarenal venous flow patterns and the renal venous stasis index indicative of effective decongestion up to a normal intrarenal venous flow pattern and renal venous stasis index. Furthermore, residual renal function increased during follow-up. This case demonstrates the feasibility of renal Doppler ultrasonography as a simple, non-invasive, and integrative measure of renal congestion. The renal venous stasis index and intrarenal venous flow patterns may be useful to evaluate the treatment response and to guide therapy in patients with right heart failure.

Keywords
Cardiorenal syndromes
pulmonary hypertension
renal Doppler ultrasonography
venous congestion
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